Stimulus Plan Includes Billions for Doctors, Hospitals

WASHINGTON – Dr. Cecil Wilson is in no rush to convert his nearly 5,000 patient charts from paper to digital.

Wilson, an internist in Winter Park, Fla., says converting records for his 30-year practice would cost more than he wants to pay and would take time away from his patients.

"Those kind of challenges make it difficult for doctors like myself to say, 'OK this coming year, I'm going to invest an additional $30,000 to $40,000 in a new system," said Wilson, a trustee for the American Medical Association.

Wilson is not alone. Five years after President Bush announced plans for Americans' health records to go digital and didn't provide enough money to make it happen, only one in five doctors has converted from paper to electronic record keeping.

When Barack Obama takes over the White House next week, this could change. During his campaign for president, Obama promised a $50 billion investment to store patient records electronically. His economic stimulus package is expected to contain two year's worth of funding, or about $20 billion.

The money would be distributed to hospitals and doctors through grants and through higher reimbursement rates when serving Medicare patients. And for doctors who do not make the switch, Obama will propose lowering reimbursements from government-subsidized health care programs.

"They're talking about real dollars that will make a big impact on adoption," said Kara Calvert, director of government relations for the Information Technology Industry Council, a trade group.

Instead of broadly subsidizing the conversion to digital records on a broad scale, the Bush administration relaxed federal regulations so that hospitals, insurers and others could provide equipment and software to physicians without fear of violating anti-kickback laws.

The Bush administration also set standards to ensure that computer systems can exchange important patient data, a lengthy and complex task involving negotiations with equipment and software vendors, health care providers and government officials.

Health and Human Services Secretary Mike Leavitt said that spending tens of billions of dollars before the appropriate standards are in place would have been wasteful. "The system wasn't ready for it," Leavitt said.

Senate Health Committee Chairman Edward M. Kennedy said that although the Bush administration has made progress, particularly with its appointment of a national policy coordinator, it has not done enough.

Leavitt said he is confident that Bush's goal of widespread use by 2014 will still be met, even though many analysts are skeptical.

"We're going to get there by 2014. Think of a building. What happens? The first six months, trucks and people go into the hole and you don't see anything happen," Leavitt said. "Then the framers come in and it just pops into the sky. The framers in this case may be the stimulus package."

Catherine DesRoches, who led a government-funded study on electronic record keeping, said doctors in large practices are most likely to do away with the paperwork. With practices containing 50 or more doctors, half use computer records.

"That number just falls dramatically after that," said DesRoches, an instructor in medicine at Harvard Medical School and senior scientist for health policy at Massachusetts General Hospital.

DesRoches said nearly half of all doctors practice in one or two-person offices. They tend to focus on primary care and are less likely to have converted to electronic record keeping.

"When we're talking about providers in large group practice, that's one kind of story, but when we talking about individual doctors, their margin of profit is probably slimmer than we think," she said.

As a result, DesRoches said grants, low-interest loans and higher reimbursements from government programs like Medicare are necessary to speed up the use of electronic health records.

The federal government took a similar approach this year when encouraging doctors to issue prescriptions electronically. Doctors who regularly use "e-prescribing" will get a slight boost in Medicare payments over the next five years. Doctors who don't could see cuts in their Medicare reimbursement rates beginning in 2012.

With e-prescribing, doctors can see which medicines are the safest and most affordable for a particular patient. But it's not as complete as full patient health records. The fuller records would include things such as X-ray results, lab tests and past serious illnesses.

While progress has been made in setting standards for sharing data, it's still common for doctors to have computers that cannot share data with their local hospital.

"We're sort of in this strange phase right now," said DesRoches. "There are a lot of systems out there, but they don't talk to each other and it's cumbersome to use them."